Rising global Ties in orthopaedic research: A 30-year analysis of high-impact journals

International collaboration has increased across scientific fields, yet its role within orthopaedic surgery remains poorly defined. Although global orthopaedic research output has expanded, the extent of international authorship within leading journals and its relationship to academic influence are not well understood. This study examined long-term publication patterns to compare international and single-country authorship and to determine whether collaborative research is associated with greater citation impact.

This bibliometric study analyzed 91,799 original research articles published from 1990 to 2019 in fifteen major orthopaedic journals. Articles were classified as single-country publications or international collaborations based on the institutional affiliations of contributing authors. Citation counts and citations per publication per year were calculated. Multivariable linear regression was used to evaluate the association between international collaboration and citation impact while adjusting for established citation-related factors. Propensity score matching using a three-to-one nearest-neighbor approach was performed to reduce confounding.

Of 91,799 articles, single-country publications accounted for 87.7 percent overall but decreased over time, while international collaborations increased from 5.9 percent in the 1990s to 15.8 percent in the 2010s. Collaborative publications received more total citations and more citations per publication per year than single-country publications. Collaborative studies also had more authors, keywords, and references, and were more likely to report funding and open access. Regression and matched analyses identified international collaboration as an independent predictor of higher citation impact. The United States produced the largest number of publications and demonstrated higher citation rates when collaborating internationally.

International collaboration in orthopaedic research has increased substantially and is associated with greater academic influence compared with research conducted within a single country. These findings highlight the value of global engagement in producing high-impact orthopaedic scholarship.